Healthcare Provider Details

I. General information

NPI: 1366353336
Provider Name (Legal Business Name): RACHAEL BURUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EASTBROOK RD STE 101-102
DEDHAM MA
02026-2048
US

IV. Provider business mailing address

30 EASTBROOK RD STE 101-102
DEDHAM MA
02026-2048
US

V. Phone/Fax

Practice location:
  • Phone: 857-293-5020
  • Fax: 857-226-8772
Mailing address:
  • Phone: 857-293-5020
  • Fax: 857-226-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLSMHC1081
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: